MEDICARE: DR. KURT T WHITAKER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	DR.0042353	CO
2	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	6176544-1205	UT
3	207R00000X	Internal Medicine Physician	42353	CO

General Provider Information

NPI Number	:	1821018318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KURT T WHITAKER MD

Provider Business Mailing Address
First Line	:	641 CHEYENNE DR
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-9192
Country	:	US
Telephone Number	:	303-929-1910
Fax Number	:

Provider Business Practice Location Address
First Line	:	641 CHEYENNE DR
Second Line	:
City	:	LAFAYETTE
State	:	CO
Zip	:	80026-9192
Country	:	US
Telephone Number	:	303-929-1910
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	06/18/2025

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